Abstract
Objective
To compare body iron stores in late preterm and term small for gestational age (SGA) infants with gestation matched appropriate-for-gestational age (AGA) infants at birth and at 2 mo of age.
Methods
In this prospective observational study, live births of 34–42 wk gestation and SGA (<10th centile for GA) were enrolled along with gestation matched AGA (10th-90th centile for GA) infants. Infants’ blood samples were taken within 2 h of delivery, and repeated at 60 ± 7 d of life. Primary outcome was serum ferritin at birth and 60 d of age. Secondary outcomes were hematocrit at birth and 60 d and need for transfusion until 60 d of life.
Results
A total of 37 SGA (gestation 37.2 ± 1.9 wk, birth weight 1861 ± 401 g) and 30 AGA infants (gestation 37.3 ± 1.9 wk, birth weight 2607 ± 405 g) were enrolled in the study. There was no difference in the serum ferritin between AGA and SGA infants at birth {median [IQR]: 254.0 [214.3–293.8] vs. 259.7 [217.8–301.5] μg/L; p = 0.85} or 60 d of life {147.2 [101.4–193.0] vs. 155.0 [106.6–203.6] μg/L; p = 0.81}. Mean hematocrit was 55.5 ± 9.6 vs. 52.4 ± 5.0 at birth (p = 0.10) and 32.1 ± 4.9 vs. 31.6 ± 3.8 at 60 d (p = 0.77) in SGA and AGA infants respectively. No infant required blood transfusion during the study period.
Conclusions
Iron stores of late preterm and term SGA infants are comparable to term AGA infants at birth and 2 mo of age. Recommendations on iron supplementation to these infants need to be formulated through appropriately designed randomized trials.
Similar content being viewed by others
References
Lee AC, Katz J, Blencowe H, et al; CHERG SGA-Preterm Birth Working Group. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1:e26–36.
Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162–72.
Siddappa AM, Rao R, Long JD, Widness JA, Georgieff MK. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations. Neonatology. 2007;92:73–82.
Oski FA. Iron requirements of the premature infant. In: Oski FA, editor. Hematologic problems in newborn. 3rd ed. Philadelphia: WB Saunders; 1982. p. 56–86.
Hågå P. Plasma ferritin concentrations in preterm infants in cord blood and during the early anaemia of prematurity. Acta Pediatr Scand. 1980;69:637–41.
Chockalingam UM, Murphy E, Ophoven JC, Weisdorf SA, Georgieff MK. Cord transferrin and ferritin values in newborn infants at risk for prenatal uteroplacental insufficiency and chronic hypoxia. J Pediatr. 1987;111:283–6.
Briana DD, Boutsikou T, Baka S, et al. Perinatal role of hepcidin and iron homeostasis in full-term intrauterine growth-restricted infants. Eur J Hematol. 2013;90:37–44.
Karaduman D, Ergin H, Kilic I. Serum ferritin, iron levels and iron binding capacity in asymmetric SGA babies. Turk J Pediatr. 2001;43:121–4.
Mukhopadhyay K, Yadav RK, Kishore SS, Garewal G, Jain V, Narang A. Iron status at birth and at 4 weeks in term small-for-gestation infants in comparison with appropriate-for-gestation infants. J Matern Fetal Neonatal Med. 2011;24:886–90.
Pussick NMdeF, Oliveira AAM, Conceição PSM, da Rocha MFE. Erythrocyte indices and serum ferritin in newborns. Rev Bras Hematol Hemoter. 2010;32:365–370. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-84842010000500008&lng=en.http://dx.doi.org/10.1590/S1516-84842010000500008.
Ballard JL, Khoury JC, Wedig K, et al. New Ballard Score, expanded to include extremely premature infants. J Pediatrics. 1991;119:417–23.
Singh M, Giri SK, Ramachandran K. Intrauterine growth curve for live-born babies. Indian Pediatr. 1974;11:475–9.
WHO. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012. Available at: http://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdf. Accessed 24th August 2015.
Kumar P, Sankar MJ, Sapra S, Agarwal R, Deorari AK, Paul VK. Follow-up of high risk neonates. Indian J Pediatr. 2008;75:479–87.
Berglund S, Westrup B, Domellöf M. Iron supplements reduce the risk of iron deficiency anemia in marginally low birth weight infants. Pediatrics. 2010;126:e874–83.
Aggarwal D, Sachdev HPS, Nagpal J, Singh T, Mallika V. Haematological effect of iron supplementation in breast fed term low birth weight infants. Arch Dis Child. 2005;90:26–9.
Schiza V, Giapros V, Pantou K, Theocharis P, Challa A, Andronikou S. Serum transferrin receptor, ferritin, and reticulocyte maturity indices during the first year of life in 'large' preterm infants. Eur J Haematol. 2007;79:439–46.
Agarwal R, Virmani D, Jaipal M, et al. Investigators of LBW Micronutrient Study Group. Iron stores in low and normal birth weight infants at birth and in early infancy. Indian J Pediatr. 2014;81:279–82.
Mills RJ, Davies MW. Enteral iron supplementation in preterm and low birth weight infants. Cochrane Database Syst Rev. 2012;3:CD005095.
Lind T, Seswandhana R, Persson LA, Lönnerdal B. Iron supplementation of iron-replete Indonesian infants is associated with reduced weight-for-age. Acta Paediatr. 2008;97:770–5.
Majumdar I, Paul P, Talib VH, Ranga S. The effect of iron therapy on the growth of iron-replete and iron-deplete children. J Trop Pediatr. 2003;49:84–8.
Dewey KG, Domellöf M, Cohen RJ, Landa Rivera L, Hernell O, Lönnerdal B. Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. J Nutr. 2002;132:3249–55.
Idjradinata P, Watkins WE, Pollitt E. Adverse effect of iron supplementation on weight gain of iron-replete young children. Lancet. 1994;343:1252–4.
Jaime-Perez JC, Herrera-Garza JL, Gomez-Almaguer D. Suboptimal fetal iron acquisition under a maternal environment. Arch Med Res. 2005;36:598–602.
Contributions
BS conceptualized and designed the study, did data collection and analysis, drafted the initial manuscript. SG helped in drafting, critical revision and finalization of the manuscript. MJS, RA, AKD, VKP contributed to the study design, data collection, analysis and interpretation, and also critically reviewed the manuscript. NG performed the analysis of samples for serum ferritin. MJS finalized the manuscript and shall act as the overall guarantor.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
None.
Source of Funding
None.
Rights and permissions
About this article
Cite this article
Saha, B., Jeeva Sankar, M., Gupta, S. et al. Iron Stores in Term and Late Preterm Small for Gestational Age and Appropriate for Gestational Age Neonates at Birth and in Early Infancy. Indian J Pediatr 83, 622–627 (2016). https://doi.org/10.1007/s12098-015-1960-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-015-1960-7